Aesculap Spine S 4 Spinal System. Instrumentation Guide

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Spencer West
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1 Aesculap Spine S 4 Spinal System Instrumentation Guide

2 S 4 Spinal System S 4 From initial conception, the S 4 Spinal System was developed to meet the spine surgeon s need for an extremely low profile and incredibly stable thoracolumbar spinal fixation system. By combining the exceptionally small yet stable design of the screw construct with simple instrumentation, the S 4 Spinal System emerges as a remarkably safe system for posterior column fixation. The development elements small, stable, simple, and safe define the S 4 Spinal System as the state-of-the-art pedicle fixation system of choice for surgeons requiring performance oriented top-loading pedicle screw systems! Small The S 4 Spinal System features a revolutionary pressure vessel design capable of delivering unmatched biomechanical stability while maintaining an exceptionally small implant volume. This low profile, low volume aspect of S 4 reduces the risk of facet and soft tissue impingement which ultimately leads to better mechanical stability and reduced soft tissue irritation. S 4 also features an inner set screw for locking the construct which greatly improves distraction and compression maneuvers and guarantees a low run on the rod throughout all implant components! Stable The S 4 Spinal System features a unique closure mechanism that maximizes surface contact area which effortlessly stabilizes the whole construct and ensures a high overall biomechanical strength. In addition, the interconnection strength between the bone screw and body is extremely stable due to a special shaped seat inside the body which creates the revolutionary pressure vessel that efficiently transfers force throughout the rod-screw construct. Lateral stability can also be achieved with S 4 using the various rigid and adjustable cross-connectors! 2

3 Simple S 4 s instruments were designed to meet the surgeons demand for a quicker yet simpler operational procedure. The multiaxial capability of the polyaxial screws provide 42 total range of motion, which allows for easier rod placement and reduction. The small implant volume greatly improves distraction and compression maneuvers, especially in narrow conditions, and enhances the surgeon s ability to place interbody fusion spacers when distracting off pedicle screws. By combining the S 4 Spinal System with the ProSpace interbody fusion spacers, Aesculap offers a true three-column stabilization portfolio, capable of providing the surgeon all it takes to operate in spine surgery! Safe The top-loading, inner set screw of S 4 features an exclusive undercut thread design that virtually eliminates cross threading. This unique undercut thread actually directs the forces inward to prevent splaying of the body, which ultimately results in improved force transmission and efficiency throughout the rod screw construct. S 4 s small volume and low profile design also minimizes interference with anatomical structures thereby allowing the surgeon the ability to remove less facet joint! 3

4 S 4 Spinal System Content 1. Pedicle Preparation 5 2. Tapping 7 3. Screw Application Monoaxial Screw Application Polyaxial Screw Application Screw Body Manipulation Rod Placement Set Screw Starting for Monoaxial and Polyaxial Screws Reduction Maneuvers Compression Maneuvers Rotation Maneuvers Final Tightening Tab Removal Cross Connector Placement Final Construct Implants Implant Description Implant Tray Set-Up Recommendation Instruments Instrument Description Instrument Set Configuration 34 4

1. Pedicle Preparation 1. After determination of the pedicle entry point use the bone awl FW190R to open the pedicle canal (Fig. 1). Bone awl FW190R Fig.

5 1. Pedicle Preparation 1. After determination of the pedicle entry point use the bone awl FW190R to open the pedicle canal (Fig. 1). Bone awl FW190R Fig. 1: Opening the pedicle canal Perforation of the pedicle is performed with the straight or curved blunt-tip pedicle probes FW188R and FW189R. The probes have ruled markings to determine the depth measurement in the pedicle canal. This assists with screw length selection (Fig. 2). Straight pedicle probe FW188R Curved pedicle probe FW189R Fig. 2: Perforate the pedicle canal with straight or curved pedicle probe 5

6 S 4 Spinal System 1. Utilize the straight or curved pedicle sounder FW146R or FW147R to confirm the patency of the pedicle and vertebral body cortex (Fig. 3). Fig. 3: Palpation for perforations in the pedicle wall Straight pedicle sounder FW146R Curved pedicle sounder FW147R If necessary, the single or dual band pedicle markers FW191R or FW192R can be used to identify proper anatomic location on intra-operative radiographic imaging. Single band pedicle marker FW191R Dual band pedicle marker FW192R 6

7 2. Tapping 2. Although the S 4 Spinal System screws are self-tapping, screw taps are available in all diameters if desired (Fig. 4). To tap attach the ratchet handle FW165R to the appropriate tap, based on the screw diameter. Fig. 4: Tapping the pedicle canal Screw tap FW194R ø 4.5mm, blue FW195R ø 5.0mm, yellow FW196R ø 6.0mm, grey FW197R ø 7.0mm, light blue FW198R ø 8.0mm, purple Ratchet handle FW165R 7

S 4 Spinal System 3. Screw Application 3. Once the pedicle has been prepared, select the appropriate screw length and width. Color-coded polyaxial and monoaxial screws are available in 4.

8 S 4 Spinal System 3. Screw Application 3. Once the pedicle has been prepared, select the appropriate screw length and width. Color-coded polyaxial and monoaxial screws are available in 4.5mm (blue), 5.0mm (gold), 6.0mm (grey), 7.0mm (light blue) and 8.0mm (purple) diameter and vary in length from 25 to 60mm. Screwdriver with retaining clip for polyaxial screws FW173R ø 5.0mm Monoaxial screw ø 5.0mm Polyaxial screw Screwdriver for monoaxial screws FW176R Select the appropriate screwdriver based on the screw style. For monoaxial screws, use the rounded tip monoaxial screwdriver FW165R; for polyaxial screws use the self-retaining polyaxial screwdriver FW173R. Ratchet handle FW165R Attach the ratchet handle FW165R to the appropriate screwdriver. 8

3.1 Monoaxial Screw Application To place a monoaxial screw, insert and fully seat the rounded tip of the monoaxial screwdriver FW176R into the slot of the monoaxial screw (Fig.

9 3.1 Monoaxial Screw Application To place a monoaxial screw, insert and fully seat the rounded tip of the monoaxial screwdriver FW176R into the slot of the monoaxial screw (Fig. 5) then thread the screw into the prepared pedicle (Fig. 6). 3.1 Repeat this process until all screws are placed. For screw body manipulation the monoaxial screwdriver FW176R can be used or alternatively the screw body manipulator FW180R (see section 5). Fig. 5: Monoaxial screwdriver assembly Fig. 6: Insertion of a monoaxial screw Screwdriver for monoaxial screws FW176R Fig. 7: Completed screw insertion 9

S 4 Spinal System 3.2 3.2 Polyaxial Screw Application To place a polyaxial screw, first fully engage the 3.5mm hexagonal tip of the polyaxial screwdriver FW173R into the head of the screw (Fig.

10 S 4 Spinal System Polyaxial Screw Application To place a polyaxial screw, first fully engage the 3.5mm hexagonal tip of the polyaxial screwdriver FW173R into the head of the screw (Fig. 8), then thread the screw into the prepared pedicle (Fig. 9). Screwdriver with retaining clip FW173R Note: If the polyaxicity of the screw remains, the screwdriver is not fully engaged. Fig. 8: Polyaxial screwdriver assembly Fig. 9: Insertion of a polayaxial screw Repeat this process until all screws are placed (Fig. 10). Fig. 10: Completed screw insertion 10

11 3.2 In case of soft tissue impingement, the Marnay lever FW154R can be used to retract-off a previousely placed pedicle screw thereby creating a free operating window. Marnay lever FW154R Use the shank tip screwdriver FW174R for the safe removal of polyaxial screws. Screwdriver with shank tip FW174R Monoaxial screws can be removed using the standard monoaxial screwdriver FW176R. Screwdriver for monoaxial screws FW176R 11

12 S 4 Spinal System 4. Screw Body Manipulation 4. All polyaxial screw heads have 42 range of motion (ROM) to facilitate rod placement (Fig. 11). 42 ROM Fig. 11: Polyaxial screw range of motion If desired, the screw body manipulator FW180R can be used to adjust the rotation of monoaxial screws as well as the alignment of the polyaxial screw bodies (Fig. 12). Screw body manipulator FW180R Fig. 12: Aligning the screw body 12

rod length. Disposable rod trial FW185R Both, pre-bent and straight pre-cut rods are available.

13 5. Rod Placement 5. The disposable, flexible rod trials FW185R can be used as a guide for rod bending and measuring correct rod length. Disposable rod trial FW185R Both, pre-bent and straight pre-cut rods are available. All rods may be contoured using the french rod bender FW024R. French rod bender FW024R Use the rod holding forceps FW012R to assist with rod placement or rod manipulation. Rod holding forceps FW012R 13

14 S 4 Spinal System 5. If necessary, the rod pusher FW513R can be used to push the rod into position. Rod pusher FW513R The rod persuader FW208R can be used to help seat the rod fully into the saddle of the screw in multisegmental cases. Using the rod persuader FW208R also simplifies set screw placement. Rod persuader FW208R 14

15 6. Set Screw Starting for Monoaxial and Polyaxial Screws 6. Pick up the set screw SW790T from the storage disc using the set screw starter FW177R. Set screw for mono-/polyaxial screw SW790T Set screw pick up from the storage disc Set screw starter FW177R Engaging the set screw SW790T with the set screw starter FW177R is only possible on the flat side of the set screw (Fig. 13), which has the 4mm hexagonal opening. Note: The set screw SW790T has to be fully engaged to the set screw starter FW177R (Fig. 14). Fig. 13: 4mm hexagonal opening Fig. 14: Fully engaged set screw 15

S 4 Spinal System 6. The outer ring of the set screw starter FW177R fits onto the flanks of the screw body to ensure the set screw SW790T trajectory is correct during initial threading (Fig. 15).

16 S 4 Spinal System 6. The outer ring of the set screw starter FW177R fits onto the flanks of the screw body to ensure the set screw SW790T trajectory is correct during initial threading (Fig. 15). Finger tighten the set screw SW790T into the screw body until it contacts the rod (Fig. 16). At this stage, compression and distraction maneuvers can still be performed. Fig. 15: Set screw insertion Fig. 16: Full engagement of the set screwdriver Repeat this process until all set screws SW790T are placed (Fig. 17). Note: The set screw starter FW177R is not designed for final tightening of the construct. It is designed to only tighten to a depth that still allows compression and distraction maneuvers to be performed. Use the set screw revision screwdriver FW193R to remove a tightened set screw SW790T. Fig. 17: Placement of the set screw using the set screw starter 16

FW184R or distraction forceps FW181R. 7.

17 7. Reduction Maneuvers 7.1 Compression Maneuvers Before final tightening of the construct, compression or distraction may be performed using the compression forceps FW184R or distraction forceps FW181R. 7.1 Distraction forceps FW181R Compression forceps FW184R or alternative FW210R If distraction or compression is desired along the rod, but not against two screws, the rod holding forceps FW012R can be placed on the rod to provide a counter-force to compress or distract against. The rod holding forceps can also be used for rotation maneuvers. Rod holding forceps FW012R 17

S 4 Spinal System 7.2 7.2 Rotation Maneuvers The de-rotation sleeves FW183R should be used during rotation maneuvers to prevent splaying of the implant head.

18 S 4 Spinal System Rotation Maneuvers The de-rotation sleeves FW183R should be used during rotation maneuvers to prevent splaying of the implant head. Place the de-rotation sleeves FW183R over the pedicle screws that contain the rod to be rotated. Connect the counter-torque L-handle FW178R to one of the de-rotation sleeves FW183R (Fig. 18) and perform the rotation maneuver. Insert the torque wrench screwdriver FW170R into the tube of the counter-torque L-handle FW178R and tighten the set screw SW790T (as described in section 8) to lock the rod from rotating. Continue locking the set screws until all are tightened. Fig. 18: Placement of the de-rotation sleeves De-rotation sleeves FW183R 18

Torque wrench with FW170R Note: It is important to only tighten the set screw SW790T to the specified setting of 10Nm (90 in/lbs).

19 8. Final Tightening 8. Final tightening of each set screw is completed using the torque limiting wrench FW170R, along with the counter-torque L-handle FW178R. Torque wrench with FW170R Note: It is important to only tighten the set screw SW790T to the specified setting of 10Nm (90 in/lbs). Over tightening will lead to damaging of the bit. Caution: Do not use the torque limiting wrench FW170R without the counter-torque L-handle FW178R. This could lead to thread jumping of the set screw within the screw body. Counter-torque L-handle FW178R 19

20 S 4 Spinal System 8. To properly tighten the set screw SW790T, use the follwing steps: Insert the torque limiting wrench FW170R through the tube of the counter-torque FW178R, so the tip is exposed Fully seat the 4mm hexagonal tip of the torque wrench into the socket of the set screw SW790T Engage the counter-torque tip FW178R with the rod. Tighten the torque wrench while applying a counter-torque with the counter-torque L-handle FW178R until the arrows on the torque wrench line up with one another Repeat this process until all sets screws SW790T are tightened (Fig. 19). Fig. 19: Placement of the counter-torque L-handle Caution: Over tightening the set screw SW790T could lead to implant failure. Damaged set screws must be replaced. Set screw revision screwdriver with 4mm hex tip FW193R Use the set screw revision screwdriver with the 4mm hex tip to FW193R to remove a previously tightened set screw SW790T. 20

9. Tab Removal 9. After verifying that all screws are placed and tightened, remove the tabs with the tab breaker FW179R (Fig. 20). Tab breaker FW179R Fig.

21 9. Tab Removal 9. After verifying that all screws are placed and tightened, remove the tabs with the tab breaker FW179R (Fig. 20). Tab breaker FW179R Fig. 20: Tab removal Note: The rod persuader FW208R can be used to help seat the rod fully into the saddle of the screw if the screw body tabs break-off prematurely which should simplify set screw placement. Rod persuader FW208R 21

S 4 Spinal System 10. Cross Connector Placement 10. Although cross connector placement is optional, they may be used to create a more rigid construct.

22 S 4 Spinal System 10. Cross Connector Placement 10. Although cross connector placement is optional, they may be used to create a more rigid construct. If a cross connector will be used, determine the appropriate size using the cross connector sizing template FW202R. Cross connector sizing template FW202R To place a cross connector, first verify there are no obstructions, then insert the cross connector. If the cross connector fits properly and is fully seated onto both rods, final tightening can be accomplished by applying 4Nm (36 in/lbs) of torque to the golden lokking screws using the cross connector torque wrench screwdriver FW207R and the cross connector counter-torque device FW204R (Fig. 21). Fig. 21: Applying the cross connector 22

23 10. Cross connector torque wrench screwdriver 4Nm (36 in/lbs) FW207R Counter-torque for cross connectors FW204R 23

24 S 4 Spinal System 10. If necessary, the adjustable cross connectors can be contoured using the cross connector bender FW203R. Place the cross connector face-up in the bender and apply the necessary force required to achieve the appropriate angle (Fig. 22). The maximum angle allowed by the cross connector bender FW203R is 20 (Fig. 23). Fig. 22: Placement of the cross connector in the cross connector bender FW203R Fig. 23: Cross connector bending Caution: Avoid bending the cross connector more than 20 or in multiple directions. This could lead to cross connector failure. Cross connector bender FW203R 24

25 11. Final Construct 11. Fig. 24: Final construct: S 4 Spinal System with cross connector and ProSpace Titanium interbody fusion implant. 25

26 Implants 12.1 Implant Description 12.1 ø 4.5mm ø 5.0mm ø 6.0mm Screws Monoaxial Transpedicular Bone Screws SW701T Monoaxial screw ø 4.5x25mm SW702T Monoaxial screw ø 4.5x30mm SW703T Monoaxial screw ø 4.5x35mm SW704T Monoaxial screw ø 4.5x40mm SW706T Monoaxial screw ø 4.5x45mm SW707T Monoaxial screw ø 4.5x50mm ø 4.5mm SW711T Monoaxial screw ø 5.0x25mm SW712T Monoaxial screw ø 5.0x30mm SW713T Monoaxial screw ø 5.0x35mm SW714T Monoaxial screw ø 5.0x40mm SW716T Monoaxial screw ø 5.0x45mm SW717T Monoaxial screw ø 5.0x50mm ø 5.0mm SW721T Monoaxial screw ø 6.0x25mm SW722T Monoaxial screw ø 6.0x30mm SW723T Monoaxial screw ø 6.0x35mm SW724T Monoaxial screw ø 6.0x40mm SW726T Monoaxial screw ø 6.0x45mm SW727T Monoaxial screw ø 6.0x50mm SW728T Monoaxial screw ø 6.0x55mm ø 6.0mm SW729T Monoaxial screw ø 6.0x60mm Polyaxial Transpedicular Bone Screws SW751T Polyaxial screw ø 4.5x25mm SW752T Polyaxial screw ø 4.5x30mm SW753T Polyaxial screw ø 4.5x35mm SW754T Polyaxial screw ø 4.5x40mm SW756T Polyaxial screw ø 4.5x45mm SW757T Polyaxial screw ø 4.5x50mm SW761T Polyaxial screw ø 5.0x25mm SW762T Polyaxial screw ø 5.0x30mm SW763T Polyaxial screw ø 5.0x35mm SW764T Polyaxial screw ø 5.0x40mm SW766T Polyaxial screw ø 5.0x45mm SW767T Polyaxial screw ø 5.0x50mm SW771T Polyaxial screw ø 6.0x25mm SW772T Polyaxial screw ø 6.0x30mm SW773T Polyaxial screw ø 6.0x35mm SW774T Polyaxial screw ø 6.0x40mm SW776T Polyaxial screw ø 6.0x45mm SW777T Polyaxial screw ø 6.0x50mm SW778T Polyaxial screw ø 6.0x55mm SW779T Polyaxial screw ø 6.0x60mm ø 7.0mm SW731T SW732T SW733T SW734T SW736T SW737T SW738T SW739T Monoaxial screw ø 7.0x25mm Monoaxial screw ø 7.0x30mm Monoaxial screw ø 7.0x35mm Monoaxial screw ø 7.0x40mm Monoaxial screw ø 7.0x45mm Monoaxial screw ø 7.0x50mm Monoaxial screw ø 7.0x55mm Monoaxial screw ø 7.0x60mm ø 7.0mm SW781T SW782T SW783T SW784T SW786T SW787T SW788T SW789T Polyaxial screw ø 7.0x25mm Polyaxial screw ø 7.0x30mm Polyaxial screw ø 7.0x35mm Polyaxial screw ø 7.0x40mm Polyaxial screw ø 7.0x45mm Polyaxial screw ø 7.0x50mm Polyaxial screw ø 7.0x55mm Polyaxial screw ø 7.0x60mm ø 8.0mm SW742T SW743T SW744T SW746T SW747T SW748T SW749T Monoaxial screw ø 8.0x30mm Monoaxial screw ø 8.0x35mm Monoaxial screw ø 8.0x40mm Monoaxial screw ø 8.0x45mm Monoaxial screw ø 8.0x50mm Monoaxial screw ø 8.0x55mm Monoaxial screw ø 8.0x60mm ø 8.0mm SW792T SW793T SW794T SW796T SW797T SW798T SW799T Polyaxial screw ø 8.0x30mm Polyaxial screw ø 8.0x35mm Polyaxial screw ø 8.0x40mm Polyaxial screw ø 8.0x45mm Polyaxial screw ø 8.0x50mm Polyaxial screw ø 8.0x55mm Polyaxial screw ø 8.0x60mm 26

27 12.1 Set screw SW790T Set screw for mono-/polyaxial screw Pre-bent Rods SW654T Pre-bent rod ø 5.5x35mm SW655T Pre-bent rod ø 5.5x40mm SW656T Pre-bent rod ø 5.5x45mm SW657T Pre-bent rod ø 5.5x50mm SW658T Pre-bent rod ø 5.5x55mm SW659T Pre-bent rod ø 5.5x60mm SW661T Pre-bent rod ø 5.5x70mm SW662T Pre-bent rod ø 5.5x80mm SW663T Pre-bent rod ø 5.5x90mm SW684T Pre-bent rod ø 5.5x100mm Straight Rods SW674T Straight rod ø 5.5x35mm SW675T Straight rod ø 5.5x40mm SW676T Straight rod ø 5.5x45mm SW677T Straight rod ø 5.5x50mm SW678T Straight rod ø 5.5x55mm SW679T Straight rod ø 5.5x60mm SW681T Straight rod ø 5.5x70mm SW682T Straight rod ø 5.5x80mm SW664T Straight rod ø 5.5x100mm SW666T Straight rod ø 5.5x120mm SW667T Straight rod ø 5.5x150mm SW668T Straight rod ø 5.5x180mm SW669T Straight rod ø 5.5x200mm SW670T Straight rod ø 5.5x300mm SW671T Straight rod ø 5.5x400mm SW672T Straight rod ø 5.5x500mm Straight Cross Connectors SW690T Cross connector L 21mm SW691T Cross connector L 25mm SW692T Cross connector L 29mm SW693T Cross connector L 32mm SW694T Cross connector L 35mm SW695T Cross connector L 38mm SW696T Cross connector L 41mm Adjustable Cross Connectors SW697T Cross connector L 43-49mm SW698T Cross connector L 49-60mm SW699T Cross connector L 60-75mm Cross Connector Screws for Replacement SW687T Locking screw purple for cross connector SW690T-SW692T SW688T Locking screw silver for cross connector SW693T-SW699T SW689T Locking screw blue for cross connector SW697T-SW699T Storage Pins for Monoaxial Screws TE864P Pin f. monoa. screws ø 4.5mm TE865P Pin f. monoa. screws ø 5.0mm TE866P Pin f. monoa. screws ø 6.0mm TE867P Pin f. monoa. screws ø 7.0mm TE868P Pin f. monoa. screws ø 8.0mm Storage Pins for Polyaxial Screws TE854P Pin f. polya. screws ø 4.5mm TE855P Pin f. polya. screws ø 5.0mm TE856P Pin f. polya. screws ø 6.0mm TE857P Pin f. polya. screws ø 7.0mm TE858P Pin f. polya. screws ø 8.0mm Note: 1 pack contains 10 pcs. 27

28 Implants 12.2 Implant Tray Set-Up Recommendation Art. Nr. Component Recommended Optional * FW161P S 4 Implant tray 1 SW790T Set screw for mono/polyaxial screw 4,5mm-7mm 16 8 SW721T Monoaxial screw ø 6.0x25mm 2 SW722T Monoaxial screw ø 6.0x30mm 4 SW723T Monoaxial screw ø 6.0x35mm 4 SW724T Monoaxial screw ø 6.0x40mm 6 SW726T Monoaxial screw ø 6.0x45mm 6 SW727T Monoaxial screw ø 6.0x50mm 6 SW728T Monoaxial screw ø 6.0x55mm 2 SW729T Monoaxial screw ø 6.0x60mm 2 SW731T Monoaxial screw ø 7.0x25mm 2 SW732T Monoaxial screw ø 7.0x30mm 4 SW733T Monoaxial screw ø 7.0x35mm 6 SW734T Monoaxial screw ø 7.0x40mm 6 SW736T Monoaxial screw ø 7.0x45mm 6 SW737T Monoaxial screw ø 7.0x50mm 4 SW738T Monoaxial screw ø 7.0x55mm 4 SW739T Monoaxial screw ø 7.0x60mm SW771T Polyaxial screw ø 6.0x25mm 2 SW772T Polyaxial screw ø 6.0x30mm 2 SW773T Polyaxial screw ø 6.0x35mm 8 SW774T Polyaxial screw ø 6.0x40mm 8 SW776T Polyaxial screw ø 6.0x45mm 8 SW777T Polyaxial screw ø 6.0x50mm 8 SW778T Polyaxial screw ø 6.0x55mm 2 SW779T Polyaxial screw ø 6.0x60mm 2 SW781T Polyaxial screw ø 7.0x25mm 2 SW782T Polyaxial screw ø 7.0x30mm 2 SW783T Polyaxial screw ø 7.0x35mm 8 SW784T Polyaxial screw ø 7.0x40mm 8 SW786T Polyaxial screw ø 7.0x45mm 8 SW787T Polyaxial screw ø 7.0x50mm 8 SW788T Polyaxial screw ø 7.0x55mm 2 SW789T Polyaxial screw ø 7.0x60mm 2 * Recommended container: JK441 for implant tray FW161P Recommended lid: JK489 for implant tray FW161P 28 Note: Storage pins for mono-/polyaxial screws are included in implant tray FW161P (detailed information see section 12.1)

29 Art. Nr. Component Recommended Optional SW690T Cross connector - straight 21mm 1 SW691T Cross connector - straight 25mm 1 SW692T Cross connector - straight 29mm 1 SW693T Cross connector - straight 32mm 1 SW694T Cross connector - straight 35mm 1 SW695T Cross connector - straight 38mm 1 1 SW696T Cross connector - straight 41mm 1 1 SW697T Cross connector - adjustable 43-49mm 1 1 SW698T Cross connector - adjustable 49-60mm 1 1 SW699T Cross connector - adjustable 60-75mm 1 1 SW653T Pre-bent rod ø 5.5x30mm 2 SW654T Pre-bent rod ø 5.5x35mm 2 SW655T Pre-bent rod ø 5.5x40mm 2 SW656T Pre-bent rod ø 5.5x45mm 2 SW657T Pre-bent rod ø 5.5x50mm 2 SW658T Pre-bent rod ø 5.5x55mm 2 SW659T Pre-bent rod ø 5.5x60mm 2 SW661T Pre-bent rod ø 5.5x70mm 2 SW662T Pre-bent rod ø 5.5x80mm 2 SW663T Pre-bent rod ø 5.5x90mm 2 SW684T Pre-bent rod ø 5.5x100mm 2 SW674T Straight rod ø 5.5x35mm 2 SW675T Straight rod ø 5.5x40mm 2 SW676T Straight rod ø 5.5x45mm 2 SW677T Straight rod ø 5.5x50mm 2 SW678T Straight rod ø 5.5x55mm 2 SW679T Straight rod ø 5.5x60mm 2 SW681T Straight rod ø 5.5x70mm 2 SW682T Straight rod ø 5.5x80mm 2 SW664T Straight rod ø 5.5x100mm 2 SW666T Straight rod ø 5.5x120mm 2 SW667T Straight rod ø 5.5x150mm 2 SW668T Straight rod ø 5.5x180mm 2 SW669T Straight rod ø 5.5x200mm 2 SW670T Straight rod ø 5.5x300mm 2 SW671T Straight rod ø 5.5x400mm 2 SW672T Straight rod ø 5.5x500mm 2 29

30 Instruments 13.1 Instrument Description Preparation FW146R Pedicle sounder, straight 2 FW147R Pedicle sounder, curved 3 FW165R Ratchet handle, straight 4 FW188R Bone probe, straight 5 FW189R Bone probe, curved 6 FW190R Bone awl 7 FW191R Pedicle marker, single band 8 FW192R Pedicle marker, dual band 9 FW194R Screw tap, ø 4.5mm FW195R Screw tap, ø 5.0mm FW196R Screw tap, ø 6.0mm FW197R Screw tap, ø 7.0mm FW198R Screw tap, ø 8.0mm 30

31 Application FW170R Torque limiting wrench (10Nm/90 in/lbs) 2 FW178R Counter-torque L-handle 3 FW173R Screwdriver for polyaxial screws 4 FW174R Screwdriver with 3.5mm hex tip 5 FW176R Screwdriver for monoaxial screws 6 FW177R Set screw starter 7 FW179R Tab breaker 8 FW180R Screw body manipulator 9 FW193R Set screw revision screwdriver 4mm hex tip 10 FW154R Marnay lever 10 31

32 Instruments 13.1 Instrument Description Cross Connector Application FW202R Cross connector sizing template 2 FW203R Cross connector bender 3 FW204R Counter-torque for cross connectors 4 FW207R Cross connector torque wrench (4Nm/36 in/lbs) 32

33 Rod bending and reconstruction FW012R Rod holding forceps 2 FW185R Rod trial single use 3 FW024R French rod bender 4 FW513R Rod pusher 5 FW208R Rod persuader 6 FW181R Distraction forceps 7 FW184R Compression forceps 8 FW183R De-rotation sleeves 9 FW210R Compression forceps

34 Instruments 13.2 Instrument Set Configuration Art. Nr. Component Recommended Optional Trays 1 * FW163P Tray Preparation & Application (I) 1 * FW164P Tray Rod Bending & Reconstruction (II) 1 Preparation FW146R Pedicle sounder, curved 1 FW147R Pedicle sounder, straight 1 FW165R Ratchet handle, straight 2 FW188R Bone probe, straight 1 FW189R Bone probe, curved 1 FW190R Bone awl 1 FW191R Pedicle marker, single band 4 2 FW192R Pedicle marker, dual band 4 2 FW194R Screw tap, ø 4.5mm 1 FW195R Screw tap, ø 5.0mm 1 FW196R Screw tap, ø 6.0mm 1 FW197R Screw tap, ø 7.0mm 1 FW198R Screw tap, ø 8.0mm 1 Application FW170R Torque limiting wrench (10Nm/90 in/lbs) 1 FW173R Screwdriver for polyaxial screws 2 FW174R Screwdriver with 3.5mm hex tip 1 FW176R Screwdriver for monoaxial screws 2 FW177R Set screw starter 2 FW178R Counter-torque L-handle 1 FW179R Tab breaker 1 FW180R Screw body manipulator 1 FW193R Set screw revision screwdriver 4mm hex tip 1 FW154R Marnay lever 2 Cross Connector Application FW202R Cross connector sizing template 1 FW203R Cross connector bender 1 FW204R Counter torque for cross connectors 1 FW206R Rod cutter 1 FW207R Cross connector torque wrench screwdriver (4Nm/36 in/lbs) 1 34 * Recommended container: JK442 for S 4 Preparation & Application (I) FW163P and Rod Bending & Reconstruction (II) FW164P Recommended lid: JK489 for S 4 Preparation & Application (I) FW163P and Rod Bending & Reconstruction (II) FW164P

35 13.2 Instrument Set Configuration Art. Nr. Component Recommended Optional Rod Bending and Reconstruction FW012R Rod holding forceps 2 FW024R French rod bender 1 FW181R Distraction forceps 1 FW184R Compression forceps 1 FW185R Rod trial, single use 2 FW513R Rod pusher 1 FW208R Rod persuader 1 FW183R De-rotation sleeves

36 All rights reserved. Technical alterations are possible. This leaflet may be used for no other purposes than offering, buying and selling of our products. No part may be copied or reproduced in any form. In the case of misuse we retain the rights to recall our catalogues and pricelists and to take legal actions. Aesculap AG & Co. KG Am Aesculap-Platz Tuttlingen Germany Phone Fax Brochure No. O /1/5

S 4. Aesculap. Spinal System. Percutaneous Approach Surgical Technique. Aesculap Spine

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